Project Summary/Abstract In this research plan, we examine associations between dynamic aspects of workload, workforce, and quality of care at children's hospitals and seek to address methodological problems of measuring utilization at hospitals, particularly in a general pediatric care setting. We adopt a multidisciplinary approach to understanding the complex nature of patient flow by applying evidence-based management and operations research to understanding how capacity may be matched to demand/need in a hospital setting and the consequences of imbalance in this relationship for quality, safety, effectiveness and efficiency of care delivered. The outcomes of this project will provide valuable tools for health services researchers, hospital leadership, regulatory agencies, and training programs to grasp the specific imbalances of workforce- workload matching that result in inefficiency or reduced quality of care. Preliminary work has focused on developing and validating administrative measures of inpatient workload, workforce, and selected quality endpoints (e.g., length of stay derivatives, medication errors, safety events, and readmissions). Aim 1 will complete the validation outlined in preliminary studies to determine the accuracy of administrative data used to determine dynamic measures of workload, workforce, and quality of care at an academic children's hospital. Aim 2 will identify workload and workforce factors associated with length of stay, readmission, and medication errors for children with common general pediatrics diagnoses. Future work aims to develop a prediction rule and examine operational strategies to prevent or respond to periods of workload and workforce mismatch in order to optimize quality and safety. The ultimate purpose of this project is to help clinicians and administrators optimize workload-workforce balance in the pediatric hospital setting to achieve safe, effective, efficient, timely, patient-centered, and equitable care for hospitalized children.